Inside the West Health Accelerator at Mass General Brigham: Embedding Delirium Prevention in the Care of Older Adults
Delirium is a serious change in mental status that often comes on quickly. It can be frightening and disruptive, affecting not only patients but also their families and care teams.
Older adults are especially vulnerable to delirium during hospitalization. According to the American Delirium Society, delirium is common in the hospital, with up to 80% of patients in intensive care units experiencing the condition. Delirium can lead to longer hospital stays, a greater chance of complications, and a higher likelihood of needing care after discharge.
But the good news is that 40% of delirium cases can be prevented. The West Health Accelerator at Mass General Brigham is taking a lead on reducing delirium in older adults by focusing on prevention, early identification, and age-appropriate care practices.
Preventing Delirium Supports Mentation
Delirium is closely connected to mentation, or mental cognition. Mentation is one of the 4Ms — mobility, mentation, medication, and what matters— a set of proven practices that guide appropriate care for older adults.
“Once a patient develops delirium, they are more likely to have a longer hospital stay, experience complications like falls, and be discharged somewhere other than home,” says Amy Bulger, RN, MPH, GERO-BC, CPHQ, director of nursing strategy and implementation for the West Health Accelerator. “Delirium also creates stress and worry for families. That’s why prevention is such an important focus of our work on the Accelerator.”
A Team-Based Approach to Prevention
Preventing delirium requires thoughtful, coordinated care across a patient’s entire hospital stay. Through the West Health Accelerator, teams across Mass General Brigham are focusing on everyday routines that support patients’ physical and mental health by hardwiring best practices into Epic, the electronic health record, and embedding appropriate older-adult care into nursing plans.
These efforts include:
Managing pain carefully, avoiding overmedication while ensuring comfort
Encouraging movement, such as getting out of bed and walking as early and safely as possible
Promoting good sleep, by dimming lights and reducing nighttime noise and unnecessary interruptions
Supporting hydration and nutrition, including help with meals if needed
Preventing constipation and urinary retention, which can contribute to delirium
Removing unnecessary medical devices, such as urinary catheters or cardiac monitors, as soon as possible
Decreasing the use of potentially inappropriate medications, reducing the potential for developing delirium
Staff are also being trained on the importance of helping patients stay oriented and engaged. That means keeping glasses, hearing aids, and dentures within reach, encouraging familiar routines, bringing in personal items from home, and involving family members whenever possible.
“When older adults can’t see or hear well, it can quickly contribute to delirium,” Bulger explains. “Something as simple as ensuring someone has their glasses or hearing aids can make a big difference.”
Identifying Delirium Early
Even with strong prevention efforts, delirium can still occur, making early identification another goal of the Accelerator. Nurses regularly screen older adults for signs of delirium or changes in mentation during their hospital stay. If a change is identified, the care team can respond quickly by looking for underlying causes such as infection, dehydration, or medication.
Catching delirium early allows teams to adjust care plans, eliminate unnecessary medications or devices, and increase supportive measures that help patients recover.
A Systemwide Commitment to Reduce Delirium
Through the West Health Accelerator, Mass General Brigham is streamlining consistent best practice delirium prevention interventions into everyday care — from nursing plans and mobility tools to medication safety and discharge education.
“This work brings together nurses, physicians, therapists, and families around a shared goal,” Bulger says. “By implementing these practices and focusing on what matters most to older adults, we can reduce delirium, improve outcomes, and make the hospital experience safer and more supportive.”